U.S. vs. Indiana

Abortions, Planned Parenthood and funding

June 17, 2011

Last month, Indiana Gov. Mitch Daniels signed legislation that denies public funding to any health care provider that performs abortions. Hospitals are exempt from the law, so the most significant impact is on Planned Parenthood, which is the largest provider of health care to women in the state.

Federal law prohibits the use of federal money to pay for abortions. The law in Indiana essentially extends that to deny funding for all health services to any agency that provides abortions. Several other states are debating similar legislation.

The feds, however, are saying: Not so fast.

Cindy Mann, a director of Medicaid, has notified state Medicaid administrators that the states cannot limit a patient's choice of doctors. "Medicaid programs may not exclude qualified health care providers … from prohibiting services under the program because they separately provide abortion services (not funded by federal Medicaid dollars, consistent with the federal prohibition) as part of their scope of practice."

Another Medicaid official, Dr. Donald Berwick, notified Indiana's social services administration that it could face penalties. Read: We'll take some of your money away.

Indiana hasn't budged, though. The Indiana Family and Social Services Administration and the state attorney general's office have said they will stand by the state law. The dispute has moved to federal court, where Planned Parenthood and the ACLU are arguing that the law flouts established Medicaid guidelines.

Federal law does seem clear, and not in Indiana's favor. The Social Security Act says: "Any individual eligible for medical assistance … may obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service or services required." That is to say, patients on Medicaid can choose any qualified provider that accepts Medicaid.

The Justice Department said as much in a court filing Thursday, arguing that "a state's criteria for qualification must be related to the provider's ability to render services and properly bill for those services."

That's the law — and it's sound policy.

Indiana has 28 Planned Parenthood clinics, only four of which perform abortions. Yet the state law blocks funding for all of them. Planned Parenthood says seven of its clinics could close by June 20 if the state law isn't reversed.

Indiana is likely to lose in court. The greater concern is that if the state loses, the stakes will rise enormously.

Indiana could decide to withdraw entirely from Medicaid—a sobering prospect, given that more than 1 million people in the state, about one-sixth of the population, are on Medicaid. The idea of pulling out of Medicaid is being debated in a number of states that are rankled by the rising costs of the program and the prospect that those costs will grow even faster under national health care.

There are many sound ways to make abortion safe, legal and rare. Denying health care to poor women isn't one of them.